How to stop the cycle of chronic childhood ear infections

Most kids get an ear infection in their first few years because their immune system is just developing. For some, ear infections become chronic & require antibiotics, which can actually disrupt the natural bacterial balance of the nose & sinuses, leaving the child more at risk for future infections. Find out an easy way to intervene at home to stop this cycle.

What is an ear infection?

Ear infections are prevalent in children; however, there are three different types of ear infections, which can be confusing.

Acute otitis media (AOM) is the term for middle ear infections.^[1][9] Acute otitis media is one of the most common illnesses evaluated by pediatricians and is often related to a current or recent upper viral respiratory tract infection, also known as a common cold. (1,8) About 50% of all children will have at least one ear infection by the time they reach their second birthday.^[1]

Otitis media with effusion (OME) occurs when fluid in the middle ear space is not infected, and this type of ear infection does not require antibiotics. ^[1][8] OME, or “glue ear,” is when fluid is in the middle ear without acute infection symptoms that can cause temporary hearing loss and has been identified as a principal cause of balance instabilities and vertigo in children.^[1][2][8]

Otitis externa is an infection of the space outside of the eardrum and involves the ear canal. Sometimes, this condition is known as swimmer’s ear.^[1][3][8] The most common cause of acute otitis externa is a bacterial infection, which may be associated with allergies, eczema, and psoriasis.^[3] Oral antibiotics have not been proven beneficial, and their inappropriate use will increase resistance among common otitis externa pathogens.^[3]

Ear infection symptoms

Chronic ear infections should not be ignored because they can lead to serious health conditions.

Some of the most common symptoms of an ear infection are pain, fever, difficulty hearing, and pressure inside the ear. Children may start to pull at their ears, lose their balance, and experience a reduction in energy. Chronic ear infections begin as acute infections that leave a hole in your ear that never heals, allowing bacteria to worsen the condition. Other complications of chronic ear infections include an eardrum to burst, headaches, dizziness, or ringing in the ears (tinnitus).

One rare disorder of chronic ear infections is palatal myoclonus, a rhythmic, involuntary, jerking movement of the soft palate.^[4][5][6] This condition means the muscle in the back of the throat constantly twitches, sometimes with an audible clicking noise. The only treatment options provided were surgically cutting the muscle, placing Botox injections, or leaving it as is.

People with chronic ear infections can develop a cholesteatoma in the middle ear. A cholesteatoma is a growth that looks like skin and isn’t cancerous. Still, it increases your risk of having serious complications such as hearing loss that doesn’t get better, infections in other parts of your ear, the bones of your skull, or your brain, or damage to the nerve that controls movements in your face.^[7]

Ear anatomy and how it affects chronic ear infection sufferers

The inner ear is significant for hearing and balance, and chronic infection of the tonsils or adenoids can also lead to more ear infections. Your tonsils are two lymph nodes and are an important part of your immune system, helping fight off infection. Enlarged tonsils, a common cause of ear infections, occur when bacteria or viruses get trapped in the tonsils and enter the middle ear through the eustachian tube, causing inflammation and pain.

Why do kids get ear infections more than adults?

Chronic ear infections are a common problem for children but can also occur in adults. Children get ear infections more than adults because their immune systems are underdeveloped. Five out of six children will have at least one ear infection by their third birthday.^[8]

Typical treatments for kids’ ear infections?

Treatment for chronic ear infections should be individualized. Antibiotics only work against bacteria, so they can’t help with viral infections like the common cold and flu. Most ear infections can be treated with over-the-counter pain-relieving medications, rest, and extra fluids to allow your immune system to fight the infection because most ear infections only last a few days. However, children who develop problems with chronic ear infections may require surgical repair.

Probiotics can help to disrupt the cycle of ear infections

Like every parent or guardian, we do our best to protect our children from getting sick and being in pain. Oral probiotics, healthy bacteria, are one of the effective treatments for ear infections. A study testing the effectiveness of probiotics showed that taking probiotics decreased the number of children acquiring other infections or having to take antibiotics for any infection.^[9] Antibiotics kill both good and bad bacteria, and overuse can lead to antibiotic resistance. Adding probiotics to your daily regimen, in addition to proper hand hygiene, will help reduce your chances of acquiring an infection.

Lacy Walker

LACY WALKER, RDH, BS, CDA, FAAOSH - dental hygienist, speaker, owner of Shared Hygiene, LLC, & writer w/ 25 years of experience in the dental field working in a psychiatric hospital, cosmetic, restorative, DSO, and periodontal practices. Lacy is the CE Director for A Tale of Two Hygienists podcast & Public Relations Chair for the AADH. She has a passion for the oral-systemic connection & is published in DACE, RDH Magazine, & DrBicuspid. Lacy is an approved provider of CE credits through AADH.

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References

1. Paul CR, Moreno MA. Acute Otitis Media. JAMA Pediatr. 2020;174(3):308. doi:10.1001/jamapediatrics.2019.5664
2. Sabir, O. A., Johnson, E. G., Hafiz, A. E., Nelson, R. N., Hudlikar, M., Sheth, I., & Daher, N. S. (2021). Chronic Effects of Pediatric Ear Infections on Postural Stability. International journal of pediatrics, 2021, 6688991. https://doi.org/10.1155/2021/6688991
3. Medina-Blasini Y, Sharman T. Otitis Externa. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556055/
4. Palatal Myoclonus. (n.d.). Science Direct. https://www.sciencedirect.com/topics/medicine-and-dentistry/palatal-myoclonus
5. Kim JS, Caplan LR. Verterobasilar disease. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 26
6. Walker, Lacy. (2020, Jan 14). Why you need to know about palatal myoclonus. DrBicuspid. https://www.drbicuspid.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=325748
7. The Manual’s Editorial Staff. Content last modified Sep 2022.Chronic Ear Infection (Chronic Otitis Media). https://www.msdmanuals.com/home/quick-facts-ear,-nose,-and-throat-disorders/middle-ear-disorders/chronic-ear-infection-chronic-otitis-media
8. National Institute on Deafness and Other Communication Disorders. (Last Updated Date: March 16, 2022). Ear Infections in Children. https://www.nidcd.nih.gov/health/ear-infections-children
9. Scott, A. M., Clark, J., Julien, B., Islam, F., Roos, K., Grimwood, K., Little, P., & Del Mar, C. B. (2019). Probiotics for preventing acute otitis media in children. The Cochrane database of systematic reviews, 6(6), CD012941. https://doi.org/10.1002/14651858.CD012941.pub2